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Home My WebLink AboutCertificate of Titlem ELEANOR V PISANO OR WALTER W FOURNIER 14401 BALD EAGLE OR FT MYERS FL 33912-5686 Fl,LE 0"*'0,PY MAIL TO: ELEANOR V PISANO 14401 BALD EAGLE OR FT MYERS FL 33912-5686 11/20/2000 LIEN RELEASE INTEREST IN THE ABOVE DESCRIBED VEHICLE HEREBY RELEASED BY TITLE DATE ','::':,"OR ;.VESSEL--DESfiR10ED::BELOW IS`VESTEDIN 7HE-OV{-- (S). MED :-v:.:::.:;:;-::;`as:r:Ci.a::";,.....-..-..•..... ...:.... ..... . ..... . . . .. :. ..... NERNA._HEREIN,:`fHfS:-OFFICIAGaERTIFICATE-OF"TITLE': IS-:ISS _ R. SAJD--MaTOR VEHICLE .OR:,VESSEL-- --- --- ----- IDENTIF!CAT.ION.:N ..,.. ... NUPABER _ -. ..: .:..-:. . - .. ......0. 4:.on, .:::.._W - - ..." .. .L'°BHP-;-):::-.VESSEL.REGIS ..._ .....:.-...: - NO:.. :....:. ,... NUMBER ..: -8..;TITLE:: _..._ : �g.. .� REV STATE :;-COLOR: - -:: ..:.. ' ....PRIMARY.: BRAND._ ;- - . ::::...:::':--.:...::.;-_-. '?. ,-j^.x:SECONDARY.:BRAPJD: .: ';:: vb..;--:USE •. _�- .:--...:' ._ .-:.296 .. ::. ... ..... ... .: _..:,:.......... ' ?DOMEIER}STATUS: OR -VESSEL. MANUFACTURER:.::i-.::..,.:...-:.-:....:._,:...-- :.c:: :Y�HUIi� IMATERtAL ." . - _. EGI57 .. ... ... -._ R.. -.---- ------. ... �-.-:�.:._.: :...... -. ---:�� -...�- - . REL'EASEi_2O�'.�000. ..�._. : - - �'.::.:ifEN �-.. W., _. :-... ALT W FOURN IER.,:-.:-::::.'.'"..:::".--:"::::'.:::`"::..:-_-'....:.:. ..- .. .. .: --.-.- -.:---:::::.r..::--::-"-::•-: �.::::.::::.':=.:::: - .. ::.::.:: :..........:....'?'INTEREST-:INTHE:':.:'V-.ri:=.::r'':--=:::.::.:`:::.:-::::.i. �ESCit1BED:vEHICLE..IS:.:. . . .. .......... 14401::BALD-'-EAGLE:''DR,::;`.'::;:'.'::'`::�'.:-�::?.':.:-:`-:`-'.:.i-:`:.::;i-HEREBY'REC✓=ABED--;::'-:a'z .....:..........-.. -. :.:•:..:"-:::._.`'.:.:.:,:.. _::.:.. ... .... ..,.,::.7lTL T5T LIEN.HULDER::: r� i J � J rbIViSiON::OF:TVIOTOR:_VEH.ICLES::;=<:::';' - -: RIDA_ - VIE N7`:OF:IIGHWAY'%SAFETY - <,:..-: ,DEIYARI �:renects:ane. actual .mileage ol. the' -Vehicle- de;cribod hereinunless'': bAr NOT::CHECK'-: "': --.-1°a^oasr-or-my knowledge -the pdameter`readirig�:reflects: the::.!:'.�t,' r'oi:the. vdonrater.statementbldcks: is"-checked;:-:=:-i:: :.--- - ="ea irrecKanicaL'limits._:- `.-- e F 7 i h Iw' ti OX =JF:..ACTUAL" � _ amnret `pew lily 9i �at ,F6CassTef. Hi i--''-- -- _.. _. ...... -.. ....... .. .. .. .., P i STATE OF FLOREDA LIEN SATISFACTION MOTOR VEHICLES AND MOBILE HOMES - SECTION 319.24(5)(B) FLORIDA STATUTES, PROVIDES THAT UPON THE SATISFACTION OF A LIEN, THE LIENHOLDER WILL, WITHIN TEN DAYS, COMPLETE THE SPACE PROVIDED ON THE CERTIFICATE OF TITLE, DETACH THE COMPLETED LIEN SATISFACTION AND MAIL IT TO THE DEPARTMENT. IF THE CERTIFICATE OF TITLE WAS RETAINED BY THE OWNER, THE OWNER WILL, WITHIN FIVE DAYS OF THE SATISFACTION OF LIEN, DELIVER THE TITLE TO THE LIENHOLDER. THE LIENHOLDER WILL ENTER THE SATISFACTION IN THE SPACE PROVIDED ON THE FACE OF THE TIME. IF THERE ARE NO ADDITIONAL LIENS SHOWN ON THE TITLE, THE LIENHOLDER WILL DETACH THE COMPLETED LIEN SATISFACTION, AND FORWARD IT TO THE DEPARTMENT, WITHIN TEN DAYS, AND MAIL THE TITLE TO THE OWNER_ SECTION 319.24(5)(C) FLORIDA STATUTES. PROVIDES THAT IF THERE ARE ADDITIONAL LIENS NOT SATISFIED, ALIEN SATISFACTION FOR THE FIRST LIEN WILL BE GIVEN TO THE REGISTERED OWNER BY THE LIENHOLDER THE CERTIFICATE OF TITLE SHOWING A SATISFACTION OF THE FIRST LIEN WILL BE FORWARDED BY THE LIENHOLDER TO THE DEPARTMENT. VESSELS FOLLOWING SATISFACTION OF A LIEN, THE LIENHOLDER SHALL ENTER A SATISFACTION THEREOF 1N THE SPACE PROVIDED ON THE CERTIFICATE OF TITLE AND WITHIN 30 DAYS DELIVER:THE TIME CERTIFICATE TO THE REGISTERED OWNER OR SUBSEQUENT LIENHOLDER. THE ATTACJIED LIEN SATISFACTION SHOULD BE COMPLETED AND FORWARDED TP THE DEPARTMENT. Department of Highwav Safety and Motor Vehicles Neil Kirkman Building Tallahassee, F132399-0500 BRIM. ODOMETER CERTIFICATION - Frdcml and state Ions reyatre 11m1 ymi state the mpeage la cnomeane with transfer of ownership. F.— to emepute nr proHdiag a fake statement may rrndl in tines and/or Imprisonment. .$clefs:;,Dealer's:....,....:.":' ."_ .'-..Dealer's Tian .. License NO:.. ... .. ........ ...........'. Colitded i �. 1nvn'wnrroacihR.l1De dml-arttry U.I the vdddn dese 7*4-bcicin.has.Lien fransfciridoli dalce'. -.. " Rj tfie".Nnmsit ddnsc .. '? . thYc 5(�ielh]t this S er 6ifigil ahnodee: imw sad '['::- .� %+ .." _.:.- .: .. _..:: "xi �''nd'to'dic.l'eal Of 1ay:hanrledge tlritt h reflects the actual ".Re 6f the. ..... - S ...... • •. Y' .: •. _ ... - -- nm Tenifu}:ral daie.rial " ::' �=.- �-:�:.-mhidc ndnmi'irr .:.:: ". ' .'-.'.. • ... ; -. '. -.`:. , . -: '��" "_ � . . efce:iih6d 6ercin: aniess miFufU:r stamncn, bloelsiE cheekM - 7lnt rq Lh, bist of m;• kdoivL •e lttr odnmIXcr.:1- a ii'hy 6••vfy i}cn:the ltildm cfiCtding is not the nctaal w9eree. . -.. - - - . -motes'he mropA ofmi ' sgd inesTR. of ti r¢cha"a' It:mits_-:-: .::.::."..-....:. .' .ra -.: �vAR.'kT.L".'=6063,1F:TER DISCREPANCY. Signature afii� . PtacLasr_r7--' - _ .... - - Auciiou Nalite _ _ (Mann A�PRGWdcF .:11t� \Iurhr. --....'-- oc '''::.:.. :.,:-. :.DeNec3: �: •--::-; - _ .,, .. . -.: - .Name.` TCaOM,tte�ed -� lAw a'arroat Ufa title and certify that the Tehicie dcsQihni hrttln has been trmsfared uu (date) to the fationrng• " ` ' . .-.� U1Yestnic that This 3a" =6dit ortometeFwwieaiis '.;-•_- _ ---- LroTenefu)im'frs;daeltivl--".: _..:': =:::.'-----•r6-ttie - bed nfmyiaowledge}tsit rdteets r nx oriel mffem, .. -- : ` " :. "'^��v-� m ' ..' _..axhiete dnrn'lc+l 6eitin:'oatts'coe.of tfg atametu,e.e..,..;: 6?xtsi[e6as•Ied: CAI TIONeDO N(TI'CRFP-K :"'-Q:1: .I Ien•SytentifYWdt to tlKtrsr cif t) .. ....ha?t,Y�tfy.nca the adp laregling ts, 0 t"-I miles, - ..JIM IF ACTUAL ." ----: .: tnllceft amoancofva'(cf�e�W'�aesscdsa'v `tt. __- ' __:-_RfiSRtNDYt:.�bD03fG1EttafSCRFYANCY. EAce j Parchasei• -- --�-`- --" -- ., Co-Puictcnsn:.:. ... - .. .. � _ . _ .Co.Pmr➢rs�r _ _ .. ellin'Dcaler'a' _ .. �,. _ 1\amC:`... tit ' - _ __ .' .. _ - C ScBid Dcale k ldtl .. .. ...:� _.. -..:. _ .. , - .. .. o0caied g r res P Live a arranl Eds DDe avd cerli[y nmt the Tchicle domed hcicia be t j. ..V. .LWc.stete ifeat,liis 5-nr. G.ilig i_.odomctir'i+dw,teadz '�.. �..•" L' CAU7`IO,' AO NOT CIfECTi.-..'.-1-+�:.'.i hcicb}� ceniify that to the iRs _._BON'' IF ACTUAL --::.. ..-ieikYtsAw 206amofm7pgt f'arclw. ' �- CbPwchutc c r=' �. -Aticdeh'Nanai l\Yhrn�ApplicatdcY.'�`="..'-�.._ on mete I1.5.'11V 82139.''FEIDH. -" Lleahotder""s Nome: el Address'.... ..-.. .. ...-: ?. '...... .: .:.: ... NIS VEMCLE tVH3. BE"IISft.:4S -. ❑,TA]tICA�.- --,� ❑ POfSC61 5 .1RVE HERWV CERTfFY.TffAT 7HE vEHICI.E70 OE13fC6D WILLN07;7 ViVo's'tatt WuPJiti . 5' - _' . � or h"�i wmiieiv"nn,r a4id4 m • enu7'1ov:=Do,to'r--(3ECK _. p-t:' ricr t s�ti(:uat'e,t{er,.lti,df,a} Sr .-rclLi �lr<a nowanfeol-a�, in esc -`611:G o. . . IPRINTI TYPR NAME OF PURCHASERM IDL•\TICALLV AS SIG\'ED IIF].O I— '-'FiJUI#_- _--- - ---- "-' -� -"" -aod:f Dateof8"itDt :•..� -.Slate- >. - [1-LEASED -El PRtIATE:.:� -:. . ?fiRhTE4.OP2.77(��.I aDLIC fgGIi{Yi11S:0FTIHSSFhTE:.:.:�.::: '...' � ' ) rusts, d,a )heh^siofvny.Itieileledge Uidt i1 rrnecic the actoul inile5 "ofntic ".. �='�;-ciAidedescif6dl tei�Snli<ss�siftf>eidoiuefefsFatdetn[61� frii�ectsd:_ . :-:r'da�z�tl'ms =`=:-' --��:<.'� z-if�5sr�tiiri5ii-�atumets7e9+liogisaa(m_adnal ',�e•ma_ -- rrrn;mttrni;tc -;_•=-'""''-_:;:'�:.:-_:<\�,c'=ot1Gs1L1TR�aLSC1tEPANcr. . .: "DIY±• o . .. ' :.. . -. _ Rbtn 1Not aanershtp, please imiimle "aY' or'and" betnnn romes, v ao laatnuoa. •�oaa^ vID he shone. . SrATF- c':.-' =' ONDIiR Fi3!L\CITE$ OP PD_tLiDRYI DECI;gRE'7'FfA'I'YHAVE'READ 171E'40R8GQING DOCUJ7EST;L\D THAT'Tli£FaCIS ST:!'YFniti-IT ABE:TRUF: ... Sigaalum of 7sTharehasei•-.:--.- -.-•-. ..•: :'-_. -. _ -- _ _ _ _ - _ .... . .'. '(Ftrsl Name, hIIdt➢e Initial, A—* sTNmae) aJ .IT,'SESH)I7V'T[}.W;CRESIDF.,VF{=:-aL1t�V__...' Desk Birth) ® ' '.. or .. .' _ ([•Lst Names hDddlcltiUtal,.Inst Name) ........: ...:FL :.. 0 NOYRF�EN'T ❑ .V.IE�V IFtanda DLfi arFEm� -4Semad PozchaseYs to B ) BEF1205V i MAKE 1974 1 BENC . e+voo i e BODY WT - / VESSEL REGIS. NO. TITLE NUMBEi HS 49' 11582966 ELEANOR V PISANO OR WALTER W FOURNIER 14401 BALD EAGLE OR FT MYERS FL 33912-5686 I L E MAIL TO k2wopy ELEAN14401 R V PISAND AGLE 14401 BALD EAGLE DR II FT MYERS FL 33912-5686 WTI 11/20/2000 LIEN RELEASE INTEREST IN THE ABOVE DESCRIBED VEHICLE HEREBY RELEASED TITLE '.':...... re25a �1 . ., !8 TTT :;y.1/We.state�that:this ❑' ..- �:-. ,ads - (no>fen -Sell - - and.ta..tha best. . '. ,; jii�d':'r"-"r: - . :` `: :'.',:: :'✓:. of my knowledge ". --.,.. CAUTIONt-' -' 7;:.: h hareb {' reileets'the actual mileabe of'lhi ieW -" "" ' "" ...- " rhy"kiiowlhd"d iho'od'o'•� .....:..... .. . meter :reading. riii la descnbed. h¢rem,"unless--.'DD: NOT.:CHECK-❑-"--::."- lects::`ihe_ ' _._.: - .. .. :-... �.'' „blocks is"checked..--. :. - --- amauob'ote��Y't ...- _..: .'--.; - cnlea9Penaait ossofits{-- - ----- _ - mechanirSlGmits::.::,_.: .....60�-IF�-ACTUAL:::. ��':�l"ho retiy:certify.-ththa,'nd°meter: reading is--ndt acival::mileaae,:�.-:::�:: .. :.:..,:�.�:........ ....^..... - ... - UNDER::PENALTIES:=OF:':PER 1LEAGE:::=.-�[..� ..<-`�.`:VJAHNIITG:i-�p':� �- -_ ponfETEIT: olscRE �A�cv... A . HE.,FDREGOtNG:. DOCUMENT:: AND T ` :, li ,........... ...._....... � .....Pur ... ...:.......... .. :-�::.:� .: .-.-._.. .._--:-. chaser.., ..... .. ... .Name.°f;:'-:_=.>;-.:`::==.��'=�=-:`::::':::_:;:`�=.'::--:::'::�<t:�-`,::�5>:.::--::;::':::-`.:"-�::>...:-:..:'.'�:.'.-�::�::�:��: .....--- .. noted. '-::� :: - - '.'i Siriatu 'B:'a .^.........:..........::.,.-....-..:::;::_::;-':..:_:>_.:..'I'urEk6&'-'""":-"="--:_'..`_rr>'.- Co=Purcha ....Sigaalure oi:"' .... - ... -... .. .. - e=Purchase"-r:-:''':"<:.':--::'::-';::::..::'-:::':.:.:::=-:_::.i`:::_-:.:: `:::.= r: •.:.'..'.. ellerr: -:i - 'r.t't„ -..-':-.:.:: ::.'::::::: Pr Na-of .: :... `.--.�..:. .. -'..: :.:."......Seller.. ... ` GRL-- .::.- � f'�..........._......._�.'-......�-.:.;:�........ .. ....g..:�.....:!�.. .. .............: ....':.:'. ._':'.. .. .�-.:'. ...- 7:.. '._'.-;::..:. _ .. .. .... -.. :...,... ...:... ._. :..:. ..-'. :: -.: `:Printed:." me..of - .. .,.. .- - `^�'� ... - : :..... Lreensii'Naihlief-?.`.:`-::_-':..::."..:,:.. •_.::'.:::::::.-::,. - ' 5_ / STATE OF ELORIDA LIEN SATISFACTION i MOTOR VEHICLES AND MOBILE HOMES SECTION 319.24(5)(B) FLORIDA STATUTES, PROVIDES THAT UPON THE SATISFACTION OF A LIEN, THE LIENHOLDER WILL, WITHIN TIN DAYS, COMPLETE THE SPACE PROVIDED ON THE CERTIFICATE OF TITLE. DETACH THE COMPLETED LIEN SATISFACTION AND MAIL TT TO THE DEPARTMENT. IF THE CERTIFICATE OF TITLE WAS RETAINED BY THE OWNER, THE OWNER WiLL, WITHIN FIVE DAYS OF THE SATISFACTION OF LIEN, DELIVER THE TITLE TO THE LiENHOLDER. THE LIENHOLDER WILL ENTER THE SATISFACTION IN THE SPACE PROVIDED ON THE FACE OF THE TITLE_ IF THERE ARE NO ADDITTONAL LIENS SHOWN ON THE TITLE. THE LiENHOLDER WILL DETACH THE COMPLETED LiEN SATISFACTION, AND FORWARD IT TO THE DEPARTMENT, WITHIN TEN DAYS, AND MAIL THE TITLE TO THE OWNER SEC`1'ION 319.24(5)(C) FLORIDA STATUTES. PROVIDES THAT IF THERE ARE ADDITIONAL LIENS NOT SATISFIED, ArLIEN SATISFACTION FOR THE FIRST LIEN WILL BE GIVEN TO THE REGISTERED OWNER BY THE LIENHOLDER_ THE CERTIFICATE OF TITLE SHOWING A SATISFACTION OF THE FIRST LIEN WiLL BE FORWARDED BY THE LiENHOLDER TO THE DEPARTMENT. VESSELS FOLLOWING SATISFACTION OF A LIEN, THE LIENHOLDER SHALL ENTER A SATISFACTION THEREOF FN THE SPACE PROVIDED ON THE CERTIFICATE OF TITLE AND WITHIN 30 DAYS DELIVER,THE TITLE CERTIFICATE TO THE REGISTERED OWNER OR SUBSEQUENT LIENHOLDER THE ATTACHED LIEN SA77SFAC ION SHOULD BE COMPLETED AND FORWARDED TP THE DEPARTMEW. Department of Highway Safety and Motor Vehicles i Neil Kirkman Building Tallahassee, FI 32399-0500 ODOMETER CERTIFICAITON - FW-1 and w,te laws rtyobc that you state the mnmga W conntxfloo w/lh trams of ow —hip. Fal om to mmpke or providing o false statirnrent rtmy rmll fn Dttts andfor (mprkotrttrmL Selling Dmlee. ... _.._ ....... . No. = ..'`,. ;T/Wc\varraatthis tilrernadee[lifpthat'Ihe:ar}iictx do erihcM herein ltas ireeh trntiieine81. Wale) ':'in'tfieYollu..:.::::':::. , IAWs ate tb;it Ihjs ' S nr . h digit Nometir nom rc5da :]:'. =` -:.''; ' r ,:,}:.: ; ,.0 "imt Tenthcj-inilL•Ldne icid - :' �aJ fa the hesfof m}' ktiamlalgc that it reflects the arum! milmae of the ....... ..'_" .. ❑ .. ❑. - -. .:.. -.oxhide d—ribW h.-rriia oni. -nrierof, tfs Warktera[atericnt h7arte is chccktd: . . C;IUTTp?i::DO ;;NOT CHECS .... 0.1. 1 Immtiv li rtif iitat w tt.•:.-tctr et ary kaosi a the ic[dmg . i BOXIFACR�AF."-.:.'.-...'.Mlec[sihe omwrtt'Miaika�in eseecs af7 viitrtLih;ni!melts.-:......".::.. -Q:3 try tha. t)tc�hdotrsier is not .. . . tinti�W.17ER DISCREPANCY. I WCEAcr•, ..: u Sigrtabtrt of $ " - - :.:.. r v v. Pttzti_wr. . ARRTdG^: IZ 'Atrctioa 3:ame (lVfien Applicahk): � � - " - .......... ..... .... a Sdfina Itenie:`F Drater's _ -- m- tin_ .o. Selma Dmfir s Address - .. ::- .. -... _ LbRcrYcd IAVn svnrrant this title and mrtlfv that fhc 11.2lirk deusihed herein'ha, bet•n tlmat d uri (dafe) : ' - In The fofi,mrn 7AVetlmc S dmr�his❑m 6Jt;.it odoidmernrnermd's .. .. _ c,i TiFlhs -iv dar• Hal r":- " ---•+ �J Iiclzst of aec 6nmJ]Nge thu it rearm the ortrud mleafx of the' . �. �- .• � - .. 1l�J�LJ-�❑'� s�Jric4!d%s-Hied les_s.'n: mrims�mm.tf the"i�Janv-tei statrntrnt hG is is rl,ectr.d: � . F CALTION_ DO NOT CBE BECK ' .. L 1:.I6crrb}• cAifi� that tort -Est of my kmrslydactlrc artometei tr�fmg , - _; J'Ixrtri• certify0iiw di�DISCREPANCY. tc rsotYlie odml mRmee, � . �. ....,...DOS IF ACTVAI, :--:.-"rcnerfi lhratmi�fit nf-rni•.me.7ir'nre;s of its FmitG" - -: --. {VAItNT\6� o\ ' v Pomhascr. ... .. ... z G SciicdA,iot: u _ v: Aactinn N.— AWhcn .ApplicaW): -. - .-. :.... :....: ... ....... .. .'. Sclting Dm]crs .- Deniers ---'r _ _ Tax cnse No... . P . Setting Dealer's Addrrxs G . ' M, wnrmiit this filfe and remit), That tbC vetdrle dorn7ted hrrcia has Itcen"lrvasf •rrirl nu (JaNf' '--- - . Nnmetat: .. -. _ _ .. ti.ic - y 61 dat it R i.VatsL aet 1 ti.�..�df �.. rhr.arrihed in`reiz-unt�.mre'nft2r-«lomrter statti�t htwks C.-rAecb-d: CALF n6 ,e T)O NOT CRECIC ....-I'i:.. Tlirhy eetiifratnt to y �mmetntsc lhc'idamctrrera�rte _ . z .. BOX IF ACTUAL '.. ..-.: -. 2eftrus tha -r m t of mi!_^igi=.in csRcaof its mirinini V Emits : ..-...::' _ hC9 - thenamr mtime -6n�tscfRDL\CfzFJ'A Pnhihid.tinr .. - . _ ... NOTICE: Slit" PENALTY-IS,REQUIRED�fly IA-W IF NOi SUBiiFr1ED FOR ...TRAM R WITIft' 39 DAYS AFTER DATE OF PDROUSE I make application far :t Hem nrvfiruo .. title and crgislniiaa tnn,.ia. T appfinD7q for said cantor -jidr or scar! "'Irh tmn' bas7ieas as Inl7ats flFato name and address of each Genbnlder• If NONE wale NONE). RerorJ adJillonal Ilene nn Form H551V f13139-.-FEID/1 .. Liraholdrr's :Fame �... .. .. .. .. :. .... .: .:;. �,.. .. ..........' -. -Sad. Dale al girth K " . THIS VEHICIX RILL Rk; USED AS - . - .. ...: --- - : •.. - ..... ... ' < - Q TAXICAB-,. :. - to21 . J 1AVE HEREBY CFRTrk Q POLICE CAR: - _ - .... - v - }' TTFAT.THF. {'EIHtT.F TO 6F TITLED WILL NOT BF.OPERATED ON ITITE PG'BF,TC HIGI� i17 OI' TiIIS SPATE . - - � -' " .: ? IAVe avr fh5nhir S nr r, Jittir inklatr'Cr'anm scu14 _ ...., "? - .. t _ .. I _ >. ..... .... :. ` . ' Veluc hcrtiflCPnkecftr�Df the rxSttlat7er galore 61a:kc is entln).m-ss. it tetteets tre ndnal i,dti:iee of tLe Ie descr;l:et] w . G1L''TTO\::DO NOT CNECK . "' ❑ 1. I heteti_'rer[ir Zhu to i4a's= et ray isiovl6kc Ifi ddrtirr4i"ri }ing - : BOX IF.ACTUAL . - ren:-ci: the antorint of iniit:a?i in'esftticaf iR fititihauiial limit(:.'. Ihcr tv ecr!ifv_Iltal fhchdon iter w4fin is not the actual mileatz .. . -... .:. : iV.1R\T\=:ODU3FEITRtD1SCRF.PAKey . . F tinLr•,AcE ...' ... .. - ..'. 0. ..72� (tBINT(Fy.I NAi1F: O T PGRCiiASFRiSI.IUL�TfC'AIJ.Y' AS SIGNF'D OELOWt ...NOTE_• AYhrn faint oarreyttp•pirae indtsate'oi" or^nmi' tMwat„ Ham¢-Ifoo Indlmtra4 ^and" wRl be shown . ---. XIAIIANG ': CATS .. _ _ 1`ItVSIG\I:ADDIiCtiS TE � � - � � - " � �-"� � - <. 'ONnEtt PENAi. F' .--.- CITY _ 'ir :... SI.M1TE.. _ TISOI•PT.W[:R5,1 nECl.:\YtIS TTiAT7 DA\ERE1D 1}IF-PORFCOIM: DOCIfSIFls'TAN01, '1'THE-S,iCT55'I'1TF.D L`I:Tf`'A7iC."l7tt.F� u to Na .. Signature nPlst Pordeaser' ........ ' -- (First Namr, \ihlJle Joilial, Last Name) tj Ii-111iDENT fl NONRFSIDF\T.... 0-AL1F_N ...... . wwrtda DI& or FEInfU .. :Sig«•tiuic- (First Pa s Mt. of Br . tehasd - " 1)a Birth) S• rs1 Na tr 1lidJfc Initial, f 2st \amc) ..-. ❑.FL. .RE- 57DF\7.. ❑NU\RF17DF\T ";�ALIIil� � :.IFiana, ntlr or FFJnst r Date ofBirth) ..